Volume 18, Number 2, June 2006

Iliac Crest Bone Grafting of the Alveolar Cleft: Clinical and Quantitative Radiographic Assessment

Nuttawut Thuaksuban, Thongchai Nuntanaranont
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Prince of Songkla University , Hatyai , Thailand

Abstract
Objective: To evaluate the clinical results and quantitatively assess bone graft volume after secondary alveolar cleft bone grafting.
Patients and Methods: Patients and Methods: Twenty five patients with alveolar clefts (19 unilateral and 6 bilateral) were enrolled in this prospective study. All alveolar cleft defects were grafted with cancellous bone harvested from the anterior iliac crest and closed by advancement flap. Occlusal X-rays were taken preoperatively, early postoperatively, and 1, 3, 6, 12, 18, and 24 months after the operation. A custom-made film holder was used to control film-to-source distance and angulation, thus permitting a reproducible film position at each time interval. An aluminium step wedge was attached to each film for calibrating the quantitative measurement of radiographic bone density. Assessment of the bone graft was done by measurement of bone density, and bone graft height by image processing and analysis software.
Results: The average bone graft volume was 3.30 mL (SD, 1.46 mL). The duration of hospital stay was 5.30 days (SD, 1.02 days). The oronasal fistula was closed in all cases. The canines eventually erupted through the grafted area with the assistance of postoperative orthodontic treatment. Bone graft density in the cleft site rapidly decreased 1 month after the operation, becoming stable after 6 months. The bone graft height significantly decreased over 6 months (p < 0.05), then became stable. The average bone density and bone graft height reduction were 20.40% and 35.11 % , respectively.
Conclusions: Due to the large amount of cancellous bone available and low surgical morbidity, iliac crest bone grafting remains a promising method for the correction of alveolar cleft defects. However, the high resorption rate of the graft should be considered when choosing the grafting material.

Key words:
Alveolar process, Bone transplantation

Asian J Oral Maxillofac Surg. 2006;18:105-12.

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